Clinical Applications of CT Myocardial Perfusion Imaging

Cheng Xu,Yan Yi,Yining Wang 아시아심장혈관영상의학회 2020 Cardiovascular Imaging Asia Vol.4 No.4

With the continuous development of CT technology, myocardial CT perfusion imaging (CTP) has exhibited great advantages and been shown to have incremental value over coronary CT angiography, providing functional evaluation of coronary artery disease (CAD). Comprehensive assessment of CAD using cardiac CT has become feasible. This article introduces the preliminary clinical experience and advances with CTP and briefly reviews the feasibility verification, diagnostic performance, clinical strategy optimization and prognostic evaluation of CTP.

Acute Right Intracardiac Thrombus-in-Transit Complicated by Submassive Pulmonary Embolism

Raja Shariff Raja Ezman,Badrul Zaman Nazurah,Mohamad Razi Adli Azam,Najme Khir Rizmy,Kasim Sazzli 아시아심장혈관영상의학회 2021 Cardiovascular Imaging Asia Vol.5 No.1

A 61-year-old female presented with symptoms suggestive of congestive cardiac failure that was confirmed on transthoracic echocardiography (TTE) with the absence of an intracardiac thrombus. In the hospital, she suffered episodes of syncope, prompting further investigations. Repeat TTE revealed an acute mobile right atrial thrombus, and CT imaging of the pulmonary artery confirmed the presence of a massive pulmonary embolism (PE). Despite a low pulmonary embolism severity index (PESI) score, the patient underwent surgical pulmonary embolectomy. The prevalence of right-sided thrombi ranges between 4–18% in the presence of acute PE, and right-sided thrombi will almost always lead to PE. Our case highlights the limitation of the PESI score and emphasizes urgent management for the presence of a thrombus-in-transit, despite a low PESI score.

Evolution of Medical Conferences for Congenital Heart Disease Imagers in the Era of COVID-19: From Onsite to Virtual Meetings

Tsai I-Chen,Goo Hyun Woo,Latiff Haifa Abdul,Goo Seon Young,Park Sang Joon 아시아심장혈관영상의학회 2022 Cardiovascular Imaging Asia Vol.6 No.3

Due to COVID-19, onsite medical conferences were converted to virtual or hybrid formats, which have been widely accepted and successful. However, hands-on training and workshops among groups studying congenital heart disease imaging were hardly available due to their unique features requiring a high degree of interactivity. Virtual conferences are speculated to remain after the pandemic to enrich sharing ideas, concepts, and clinical experiences. Additionally, strategies utilizing augmented reality, virtual reality, and the metaverse may help reduce barriers in conducting hands-on workshops. This review illustrates various academic activities during past onsite small group conferences, suggests tips and tricks for virtual conferences, and introduces currently available innovative platforms, including the personal three-dimensional display program, hologram, and metaverse for medical education and conferences.

Relationship Between Epicardial Fat Volume and Coronary Microvascular Dysfunction in Patients with Chest Pain and Unobstructed Coronary Arteries

Jing Xian Quah,Stephanie Sargent,Karen Nel,Christopher M. Anstey,Tony Stanton,Kim Greaves 아시아심장혈관영상의학회 2020 Cardiovascular Imaging Asia Vol.4 No.1

Objective: Epicardial fat (EF) is metabolically active adipose tissue positioned between the epicardial surface of the heart and the pericardium. We investigated whether there is a relationship between EF and Coronary Microvascular Dysfunction (CMD) in patients presenting with chest pain and unobstructed coronary arteries. Materials and Methods: This study recruited patients referred to cardiology clinics for assessment of chest pain who subsequently underwent assessment via CT coronary angiogram (CTA). Myocardial blood flow reserve (MBFR) was assessed using myocardial contrast echocardiography. Epicardial fat volume (EFV) was measured by tracing serial slices on CTA with corresponding Hounsfield units of -195 to -45. Results: We recruited 134 participants with a mean age of 59.2 (9.8) years. CMD was present in 54 (40%) patients, and the measured mean EFV was 128 mm3 (96, 168). Fortythree patients (32%) had a coronary artery calcium score (CACS) of 0, 64 (48%) had a CACS of 1–100, 18 (13%) had a CACS of 101–400, and 9 (7%) had a CACS >400. Univariate regression analysis showed that EFV and MBFR had a correlation coefficient of R=-0.22, with a significant regression slope (β=-0.002, p=0.012). Multivariable linear regression analysis using MBFR as a continuous outcome variable revealed age (β=-0.012, p=0.011) and CACS (β=-0.003, p= 0.023) to be associated with MBFR. EFV was not associated with MBFR (β=-0.0007, p=0.538). Model repetition with MBFR as a dichotomous variable (MBFR ≥2 or <2) revealed no association with EFV. Conclusion: No relationship was found between EFV and MBFR when traditional cardiovascular risk factors and calcium score.

A Case of Double Orifice Mitral Valve in a Patient with Bicuspid Aortic Valve: Coincidental or a Missed Finding?

Rupinder Buttar,Khosa Gurveer Singh,Baibhav Bipul 아시아심장혈관영상의학회 2021 Cardiovascular Imaging Asia Vol.5 No.4

A 63-year-old male with past medical history of bicuspid aortic valve and ascending aortic aneurysm was referred to cardiology for aortic valve replacement (AVR) and aneurysm repair. Transthoracic echocardiogram (TTE) showed bicuspid aortic valve with severe aortic valve stenosis. Patient underwent transesophageal echocardiogram which showed an incidental finding of double orifice mitral valve (DOMV) with fusion of A/P cusps along anterolateral commissure not noted on previous TTE. Patient underwent AVR with bioprosthetic aortic valve along with resection and replacement of the ascending aortic aneurysm. No intervention was performed for the asymptomatic DOMV. DOMV is a rare congenital cardiac abnormality, easily missed on routine TTE. It warrants need for careful evaluation of mitral valve apparatus in patients with other congenital cardiac abnormalities known to be associated with DOMV.

Haemangioma in Left Atrial Appendage: Common Pathology in Uncommon Location

Ng Pan Pan,Chow Boris Chun Kei,Chiang Jeanie Betsy,Lee Jonan Chun-yin 아시아심장혈관영상의학회 2022 Cardiovascular Imaging Asia Vol.6 No.1

Cardiac haemangiomas are rare primary cardiac tumours. Patient are often asymptomatic but life-threatening complications can occur owing to tumor location. We present an asymptomatic 50-year-old lady who had incidental finding of a left atrial appendage (LAA) mass on computer tomography. Cardiac magnetic resonance imaging showed a T2-weighted hyperintense, hypervascular intraluminal LAA tumour. The signal characteristics of the cardiac tumor followed that of hepatic haemangiomas, which were inadvertently included in the same image plane, suggesting the diagnosis of cardiac haemangioma.

Polycythemia Vera Presenting as Left Ventricular Pseudoaneurysm: The Role of Multimodality Imaging

Mansour Mohamad Jihad,Haddoul Ahmad,Ohanian Antranik,El Haj Sleiman Ahmad,Osman Raed,Adhami Atika 아시아심장혈관영상의학회 2019 Cardiovascular Imaging Asia Vol.3 No.2

The association of left ventricular pseudoaneurysm (LVPA) formation to polycythemia vera (PV) is unknown and, to our knowledge, has never been reported. We describe the case of a 58- year-old man with PV who was admitted for acute dyspnea following an inferior myocardial infarction that occurred seven weeks prior to presentation. Multimodality imaging disclosed the presence of an LVPA. The patient refused surgical treatment and was readmitted three months later with acute decompensation. Follow-up imaging revealed increased LVPA. Review of the literature however showed no report of PV presenting as an LVPA that worsened in a follow-up admission. This rare association prompted a definitive diagnosis. In this case, multimodality imaging was crucial to establishing a definitive diagnosis and guiding therapy.

Thanks to the Reviewers of Cardiovascular Imaging Asia

Sang Il Choi 아시아심장혈관영상의학회 2023 Cardiovascular Imaging Asia Vol.7 No.1

The Editor-in-Chief of the Cardiovascular Imaging Asia thanks manuscript reviewers who have generously offered their time and expertise for evaluating the manuscripts submitted to the Journal from Jan. to Dec. 2022. We sincerely express our gratitude to all the reviewers listed below. Their contributions and efforts are essential to the publication and success of Cardiovascular Imaging.

Right Ventricular Mass: Thrombus or Tumor?

Zengfa Huang,Jianwei Xiao,Fen Yu,Shuang Guo,Xiang Wang 아시아심장혈관영상의학회 2023 Cardiovascular Imaging Asia Vol.7 No.1

Right ventricular (RV) thrombus is an infrequent and potentially underdiagnosed life-threatening condition. Current studies suggest that multiple non-invasive imaging modalities may be used to diagnose RV thrombus. We report a 51-year-old male patient admitted with fatigue. Transthoracic echocardiography clearly showed the location, shape, and movement of the mass. Cardiac magnetic resonance imaging further delineated the relative signal intensity and enhancement of the RV thrombus.

Duchenne Muscular Dystrophy: A Case Report and Literature

Langlang Tang 아시아심장혈관영상의학회 2023 Cardiovascular Imaging Asia Vol.7 No.1

Duchenne muscular dystrophy (DMD) is one of the first identified monogenic diseases, often leading to severe disability and early death. A boy aged 13 years 11 months presented to the hospital with chest pain for 2 hours. There was no recent history of infection. Previous myocardial zymography showed increased creatine kinase, and electrocardiogram (ECG) showed sinus arrhythmia with J-point elevation (anterior wall, inferior wall). Transthoracic echocardiography demonstrated normal left ventricular systolic and diastolic functions. Digital subtraction angiography showed good coronary angiography and ruled out myocardial infarction. Cardiac MRI (CMR) revealed massive edema and necrosis in the myocardial wall. The patient’s medical history included ECG at other hospitals (the details are unknown) that showed ST segment abnormality indicating myocardial damage. Based on this, muscular dystrophy was considered. In detecting the DMD variant gene, the patient showed homozygous deletion in exons 4–9. The mother also showed heterozygous deletion in exons 4–9 of the DMD gene, consistent with the diagnosis of DMD. Based on these findings, I diagnosed DMD. This case report highlights the role of imaging, especially CMR, in diagnosing and prognosis DMD.